Epicardial adipose tissue and cardiac lipotoxicity: A review

Epicardial adipose tissue: a new link between type 2 diabetes and heart failure-a comprehensive review

Diabetic cardiomyopathy is a unique cardiomyopathy that is common in diabetic patients, and it is also a diabetic complication for which no effective treatment is currently available. Moreover, relevant studies have revealed that a link exists between type 2 diabetes and heart failure and that abnormal thickening of EAT is inextricably linked to the development of diabetic heart failure. Numerous clinical studies have demonstrated that EAT is implicated in the pathophysiologic process of diabetic myocardial disease. In this overview, we will introduce the physiology, pathophysiology of the disease and potential therapeutic strategies, knowledge gaps, and future directions of the role of epicardial adipose tissue in type 2 diabetes mellitus and heart failure to promote the development of novel therapeutic approaches to improve the prognosis of patients with diabetic cardiomyopathy.

ACAA2 Protects Against Cardiac Dysfunction and Lipid Peroxidation in Renal Insufficiency with the Treatment of S-Nitroso-L-Cysteine

The key fatty acid β-oxidation protein acetyl-CoA acyltransferase 2 (ACAA2) plays a significant role in myocardial lipid peroxidation and cardiac dysfunction induced by renal insufficiency. However, the mechanisms of lipid metabolism related to renal insufficiency-associated cardiac dysfunction remain poorly understood, and current clinical treatments have been largely ineffective. Through analysis of the Gene Expression Omnibus (GEO) database, we identified that the cardiac functional changes caused by renal insufficiency were primarily centered around the fatty acid β-oxidation signaling pathway, where ACAA2 plays a pivotal role in fatty acid β-oxidation, the tricarboxylic acid cycle, and ketone body metabolism. In an adenine-induced renal insufficiency mouse model, further examination with hematoxylin-eosin staining, Masson staining, and Oil Red O staining revealed alterations in the heart and kidney as well as the accumulation of lipid. Non-invasive blood pressure measurements and ultrasound images demonstrated improvements of peripheral vascular and right ventricular hemodynamic parameters with S-nitroso-L-cysteine (CSNO) inhalation therapy. In cell experiments, knocking down ACAA2 led to accumulation of lipid droplets and exacerbation of oxidative stress in cardiomyocytes, while overexpression of ACAA2 reversed these effects. The transcription factor FOXO4 was found to regulate lipid peroxidation by modulating ACAA2, and knocking down FOXO4 partially restored the expression of ACAA2, reducing oxidative stress in cardiomyocytes. Furthermore, exogenous CSNO effectively restored the expression of ACAA2 and reduced the level of FOXO4, thereby mitigating lipid peroxidation and improving cardiac function. Therefore, in the context of renal insufficiency, regulating the FOXO4-ACAA2 axis through CSNO inhalation therapy may provide a novel therapeutic strategy for alleviating myocardial lipid peroxidation and improving cardiac function.

Relationship Between Epicardial Adipose Tissue and Atrial Fibrillation in Heart Failure With Preserved Ejection Fraction

INTRODUCTION AND AIM

Heart failure with preserved ejection fraction (HFpEF) is a significant clinical challenge, often coexisting with atrial fibrillation (AF), which exacerbates patient outcomes by increasing risks of stroke, hospitalizations, and mortality. Recent studies suggest that epicardial adipose tissue (EAT), a metabolically active fat depot, may contribute to AF pathogenesis by promoting atrial remodeling and fibrosis. This study aimed to evaluate the relationship between EAT thickness and AF in HFpEF patients.

MATERIALS AND METHODS

A total of 110 HFpEF patients were included, with 20 (18.2%) having documented AF. EAT thickness was measured using transthoracic echocardiography, and AF was confirmed via electrocardiography.

RESULTS

Patients with AF had significantly greater EAT thickness compared to those without AF (8.3 ± 0.9 mm vs. 7.1 ± 0.8 mm, p < 0.001). Receiver operating characteristic (ROC) analysis demonstrated that EAT thickness was a strong predictor of AF (AUC = 0.87, p < 0.001), with a cut-off value of 7.5 mm achieving 89% sensitivity and 75% specificity.

CONCLUSION

These findings indicate that increased EAT thickness is independently associated with AF in HFpEF patients, highlighting its potential as a biomarker for AF risk stratification. Future studies should explore whether targeting EAT could improve clinical outcomes in this high-risk population.

Efficacy of microbiome-targeted interventions in obesity management- A comprehensive systematic review

BACKGROUND

Obesity is a global health crisis linked to numerous chronic diseases. The gut microbiome plays a crucial role in human metabolism, and emerging evidence suggests that modulating the microbiome may offer novel therapeutic avenues for obesity management.

OBJECTIVE

This systematic review aimed to assess the efficacy and safety of microbiome-targeted interventions, including probiotics, prebiotics, synbiotics, and fecal microbiota transplantation, in improving body composition, metabolic parameters, and inflammatory markers in overweight and obese adults.

METHODS

A comprehensive search of PubMed, Scopus, and ScienceDirect was conducted to identify relevant studies published between 2005 and 2023. Included studies were assessed for methodological quality and risk of bias using the Cochrane Collaboration tool.

RESULTS

Body composition: Most studies demonstrated significant reductions in body weight, Body mass index, and body fat percentage.

METABOLIC PARAMETERS

Improvements were observed in lipid profiles (reduced cholesterol, triglycerides) and glucose metabolism (improved insulin sensitivity).

INFLAMMATORY MARKERS

Significant reductions were observed in inflammatory markers such as Interleukins (IL-6, IL-8) and C-reactive protein.

MICROBIAL COMPOSITION

Interventions generally led to shifts in microbial composition, with increases in beneficial bacteria such as Bifidobacterium and Lactobacillus.

ADVERSE EVENTS

Adverse events were generally minimal and limited.

CONCLUSION

This review provides strong evidence that microbiome-targeted interventions can effectively improve body composition, metabolic parameters, and inflammatory markers in individuals with obesity. Further research is needed to optimize intervention strategies, identify specific microbial targets, and translate these findings into effective clinical applications.

Predictive Value of Epicardial Adipose Tissue for Hemorrhagic Transformation and Functional Outcomes in Acute Ischemic Stroke Patients Undergoing Intravenous Thrombolysis Therapy

Purpose

Hemorrhagic transformation (HT) is a severe complication in patients with acute ischemic stroke (AIS) undergoing intravenous thrombolysis therapy (IVT). Epicardial adipose tissue (EAT) contributes to the development of AIS and the disruption of the blood-brain barrier. This study aims to investigate the relationship between EAT and the risk of HT, as well as functional outcomes, in AIS patients treated with IVT.

Patients and Methods

230 AIS patients were included. Epicardial adipose tissue volume (EATV) and EAT attenuation were measured from chest CT scans. Follow-up cranial CT or magnetic resonance imaging (MRI) assessed HT occurrence. Patients were stratified into groups based on the presence of HT or parenchymal hematoma (PH), and their 90-day functional outcomes (evaluated by the modified Rankin Scale).

Results

HT occurred in 52 (22.61%) patients, including 28 (12.17%) patients with PH, 85 (37.00%) patients had poor 90-day functional prognosis. Compared to the first quartile of EATV, the third quartile (OR 9.254, 95% CI 1.533-55.853) and the fourth quartile (OR 11.117, 95% CI 1.925-64.211) of EATV were independent predictors of HT; and EATV as a continuous variable (OR 1.022, 95% CI 1.005-1.040) was an independent risk factor for PH. Higher EAT attenuation was independently associated with poor prognosis (OR 1.170, 95% CI 1.056-1.297). The area under curve for predicting HT, PH and 90-day poor functional outcome was 0.705 (95% CI 0.632-0.778), 0.693 (95% CI 0.597-0.789), and 0.720 (95% CI 0.653-0.787).

Conclusion

The study demonstrates that EAT is associated with HT and poor 90-day outcomes in AIS patients undergoing IVT.

Circulating RBP4 and FABP4 concentrations in patients with chronic schizophrenia are associated with increased epicardial adipose tissue volume and metabolic syndrome

Schizophrenia has been linked to an elevated cardiovascular risk profile and premature onset of cardiovascular disease. Quantifying epicardial adipose tissue (EAT) volume provides insight into its correlation with coronary artery disease (CAD) severity and associated risk factors. Previous research indicates higher pericardial adipose tissue in individuals with schizophrenia compared to non-schizophrenic counterparts. RBP4, FABP3, and FABP4 have been implicated in CAD pathogenesis. In this study, we examined the potential increase in EAT volume in individuals with chronic schizophrenia and aimed to elucidate the relationship between circulating levels of RBP4, FABP3, and FABP4 with EAT volume and coronary artery calcium score within this cohort. We recruited 186 consecutive patients with chronic schizophrenia and utilized enzyme-linked immunosorbent assay to assess plasma concentrations of RBP4, FABP3, and FABP4. Cardiac multislice computed tomography measured EAT volume and coronary artery calcium scores. Significantly higher EAT volume in patients with chronic schizophrenia compared to controls. RBP4 associated positively with metabolic factors and EAT volumes, while FABP3 associated positively with creatinine and coronary atherosclerosis markers. FABP4 showed positive associations with metabolic factors, hypertension, and EAT volumes, but negative associations with HDL-C and eGFR. Logistic regression identified RBP4 and FABP4 as independent factors associated with increased EAT volumes, even after adjusting for known biomarkers. Both RBP4 and FABP4 were significantly associated with metabolic syndrome components and EAT volume. This study elucidates the association between chronic schizophrenia and augmented EAT volume, suggesting plausible correlations with CAD-related health complications through RBP4 and FABP4 pathways.

Remodeling of the Intracardiac Ganglia During the Development of Cardiovascular Autonomic Dysfunction in Type 2 Diabetes: Molecular Mechanisms and Therapeutics

Type 2 diabetes mellitus (T2DM) is one of the most significant health issues worldwide, with associated healthcare costs estimated to surpass USD 1054 billion by 2045. The leading cause of death in T2DM patients is the development of cardiovascular disease (CVD). In the early stages of T2DM, patients develop cardiovascular autonomic dysfunction due to the withdrawal of cardiac parasympathetic activity. Diminished cardiac parasympathetic tone can lead to cardiac arrhythmia-related sudden cardiac death, which accounts for 50% of CVD-related deaths in T2DM patients. Regulation of cardiovascular parasympathetic activity is integrated by neural circuitry at multiple levels including afferent, central, and efferent components. Efferent control of cardiac parasympathetic autonomic tone is mediated through the activity of preganglionic parasympathetic neurons located in the cardiac extensions of the vagus nerve that signals to postganglionic parasympathetic neurons located in the intracardiac ganglia (ICG) on the heart. Postganglionic parasympathetic neurons exert local control on the heart, independent of higher brain centers, through the release of neurotransmitters, such as acetylcholine. Structural and functional alterations in cardiac parasympathetic postganglionic neurons contribute to the withdrawal of cardiac parasympathetic tone, resulting in arrhythmogenesis and sudden cardiac death. This review provides an overview of the remodeling of parasympathetic postganglionic neurons in the ICG, and potential mechanisms contributing to the withdrawal of cardiac parasympathetic tone, ventricular arrhythmogenesis, and sudden cardiac death in T2DM. Improving cardiac parasympathetic tone could be a therapeutic avenue to reduce malignant ventricular arrhythmia and sudden cardiac death, increasing both the lifespan and improving quality of life of T2DM patients.

Impact of Visceral and Hepatic Fat on Cardiometabolic Health

PURPOSE OF REVIEW

Body fat distribution plays a significant role in the cardiometabolic consequences of obesity. We review the impact of visceral and hepatic fat and highlight important interventions.

RECENT FINDINGS

Several epidemiologic studies have established a clear association between visceral fat and cardiovascular disease. The association between hepatic fat and cardiovascular disease is less clear with discordant results. Novel evidence demonstrates sodium glucose co-transporter-2 (SGLT2) inhibitors facilitate modest weight loss and reductions in ectopic fat depots in patient with type 2 diabetes. Glucagon-like peptide-1 (GLP-1) receptor agonists have been associated with decreased visceral/hepatic fat and reductions in MACE in populations with type 2 diabetes and with overweight/obesity. Clear associations between visceral fat and cardiometabolic outcomes have been established, whereas the impact of hepatic fat remains less clear. Lifestyle modification and pharmacologic interventions remain the initial therapies, while surgical intervention is associated with improved long-term outcomes. Emerging therapies have demonstrated a profound impact on body fat distribution and cardiometabolic risk.

The Role of Epicardial Adipose Tissue in Acute Coronary Syndromes, Post-Infarct Remodeling and Cardiac Regeneration

Epicardial adipose tissue (EAT) is a fat deposit surrounding the heart and located under the visceral layer of the pericardium. Due to its unique features, the contribution of EAT to the pathogenesis of cardiovascular and metabolic disorders is extensively studied. Especially, EAT can be associated with the onset and development of coronary artery disease, myocardial infarction and post-infarct heart failure which all are significant problems for public health. In this article, we focus on the mechanisms of how EAT impacts acute coronary syndromes. Particular emphasis was placed on the role of inflammation and adipokines secreted by EAT. Moreover, we present how EAT affects the remodeling of the heart following myocardial infarction. We further review the role of EAT as a source of stem cells for cardiac regeneration. In addition, we describe the imaging assessment of EAT, its prognostic value, and its correlation with the clinical characteristics of patients.

Protective effects of macromolecular polyphenols, metals (zinc, selenium, and copper) - Polyphenol complexes, and different organs with an emphasis on arsenic poisoning: A review

For the potential health benefits and nutritional value, polyphenols are one of the secondary metabolites of plants that have received extensive research. It has anti-inflammatory and cytotoxicity-reducing properties in addition to a high antioxidant content. Macromolecular polyphenols and polysaccharides are biologically active natural polymers with antioxidant and anti-inflammatory potential. Arsenic is an ecologically toxic metalloid. Arsenic in drinking water is the most common way people come into contact with this metalloid. While arsenic is known to cause cancer, it is also used to treat acute promyelocytic leukemia (APL). The treatment's effectiveness is hampered by the adverse effects it can cause on the body. Oxidative stress, inflammation, and the inability to regulate cell death cause the most adverse effects. Polyphenols and other macromolecules like polysaccharides act as neuroprotectants by mitigating free radical damage, inhibiting nitric oxide (NO) production, lowering A42 fibril formation, boosting antioxidant levels, and controlling apoptosis and inflammation. To prevent the harmful effects of toxins, polyphenols and pectin lower oxidative stress, boost antioxidant levels, improve mitochondrial function, control apoptosis, and suppress inflammation. Therefore, it prevents damage to the heart, liver, kidneys, and reproductive system. This review aims to identify the effects of the polyphenols in conjugation with polysaccharides as an ameliorative strategy for arsenic-induced toxicity in various organs.